minutes of the meeting of the finance committee of the ... · charles jones, chief procurement...

Minutes of the meeting of the Finance Committee of the Board of Directors of the Cook County Health and Hospitals System held Thursday, February 20, 2020 at the hour of 9:00 A.M., at 1950 W. Polk Street, in Conference Room 5301, Chicago, Illinois.

I. Attendance/Call to Order

Chair Reiter called the meeting to order. Present: Chair Robert G. Reiter, Jr. and Directors Hon. Dennis Deer, LCPC, CCFC; Mike Koetting

(Substitute Member); and David Ernesto Munar (3)

Directors Mary Driscoll, RN, MPH and Ada Mary Gugenheim Telephonically Present: Board Chair M. Hill Hammock (Ex-Officio Member) Absent: Director Mary B. Richardson-Lowry (1)

Additional attendees and/or presenters were: Ekerete Akpan – Chief Financial Officer Debra D. Carey – Interim Chief Executive Officer Claudia Fegan, MD – Chief Medical Officer Charles Jones – Chief Procurement Officer

Jeff McCutchan –General Counsel Deborah Santana – Secretary to the Board

II. Public Speakers Chair Reiter asked the Secretary to call upon the registered public speakers. The Secretary called upon the following registered public speaker: 1. Iqbal Shariff Chief Executive Officer, Best Home Healthcare Network

Following the presentation of public testimony by Mr. Shariff, regarding receiving reimbursements on CountyCare claims, Chair Reiter indicated that the administration would follow-up on Mr. Shariff’s questions.

III. Action Items

A. Minutes of the Finance Committee Meeting, January 23, 2020

Director Munar, seconded by Director Koetting, moved to accept the Minutes of the Finance Committee Meeting of January 23, 2020. THE MOTION CARRIED UNANIMOUSLY.

Minutes of the Meeting of the Finance Committee Thursday, February 20, 2020

III. Action Items (continued) B. Contracts and Procurement Items (Attachment #1) Charles Jones, Chief Procurement Officer, provided an overview of the contractual requests presented for the Committee’s consideration. The Committee reviewed and discussed the requests. It was noted that request number 5 is being withdrawn, and the not-to-exceed dollar amount for request number 3 is being reduced to $1,000,000.00. During the discussion of request number 3, with regard to the decrease in the amount requested, Chair Reiter stated that he was concerned that approving the full amount outside of more consideration of meeting budget by the end of the year wouldn’t be appropriate; therefore, he asked Mr. Jones to amend the request to meet the current obligations and will revisit the matter in March; by that time, more data will be available to thoroughly discuss.

Director Munar, seconded by Director Koetting, moved to approve request numbers 1, 2, 3 as amended, 4 and 6 through 16, with the exception of request number 5, which was withdrawn, and subject to completion of review by Contract Compliance, where appropriate. THE MOTION CARRIED UNANIMOUSLY.

C. Any items listed under Section III

IV. Report from Chief Procurement Officer (Attachment #2) A. Report on Minority and Women-Owned Business Enterprise (M/WBE) Participation B. Report of emergency purchases

Mr. Jones provided an overview of the M/WBE Report and one (1) Report of Emergency Purchase presented for the Committee’s information. The Committee reviewed and discussed the information.

V. Report from the Chief Financial Officer (Attachment #3)

• Metrics

Ekerete Akpan, Chief Financial Officer, provided an overview of the Report from the Chief Financial Officer. The Committee reviewed and discussed the information. The Report from the Chief Financial Officer included information on the following subjects:

• January 2020 Leading Indicators – Revenue Cycles Metrics, Gross Charges and Uncompensated Care vs. DSH/BIPA Preliminary Cash Flow Projections

• Revenue Cycle Metrics as of January 2020 • Observations on Revenue Cycle Metrics • FYTD 2020 – Gross Charges as of end January 2020 • FYTD 2020 – Charity Care and Self-Pay Cost vs. DSH/BIPA funding as of end January 2020 • FY2020 - CCH Hospitals and Clinics – Preliminary Cash Flow Projections as of end January 2020


V. Report from the Chief Financial Officer (continued)

• FY2020 – Correctional Health/CCDPH Preliminary Cash Flow Projections as of end January 2020 • FY2020 – Health Plans Preliminary Cash Flow Projections as of end January 2020 • FY2020 System-wide Accrual Basis Financials, Observations as of end December 2019 • Accrual Basis Income Statement for the One Month ending December 2019 • Observations on Accrual Basis Financials • Provider of Care Services – Financial and Operational Statistics • CCH Provider – Accrual Basis Income Statement for one month ending December 2019 • Clinical Activity Observations • Stroger Operations Overview – ending December 2019 • Provident Operations Overview – ending December 2019 • ACHN Operations Overview – ending December 2019 • CountyCare Health Plan – Financial and Operational Statistics • Correctional Health Services – Financial and Operational Statistics • Cook County Department of Public Health – Financial and Operational Statistics • CCH Administration – Financial Statements • Appendix – FY2020 System-wide Volumes/Statistics

During the review of slide 4 of the presentation, regarding FYTD 2020 Revenue Cycle Metrics, the Committee held an extensive discussion on the subject of claims initial denials. Debra D. Carey, Interim Chief Executive Officer, stated that the administration is in the process of looking at the process changes and staff tasks and functions; some of it is very different from what they have been doing in the past, and some of it will require training of staff and managers. In order to get the full benefit of the new system that will be implemented, these processes have to be in place. The results will not be seen immediately, but the administration will be able to monitor very early on how well the system is being used, and adjust accordingly if needed. Director Munar inquired regarding the total actual collection rate for claims, looking at a 4-6 month window. He also inquired regarding the monetary value of the claims that are not collected. Regarding self-pay collections, he would like to see metrics on work by the vendor doing the reapplications – he wants to understand their success rate, their collections, and what is not collected. Chair Reiter indicated that he would like to have that information going into the Board Meeting next week. Mr. Akpan responded that he will see if he can turn the information around in time for the Board Meeting; additionally, he stated that he will re-circulate the presentation on Uncompensated Care that was presented several months ago.

Chair Reiter suggested that a joint meeting of the Finance and Managed Care Committees be held, or a special committee of the Board can meet, to have a thorough discussion on drivers of the financial gaps. Board Chair Hammock concurred; he recommended that a special session be held to focus on this. He stated that he will work with Chair Reiter to put together an agenda of three (3) or four (4) topics that can be dealt with in a reasonable period of time that would take the Board to a deeper level; he suggested that the recently engaged financial consultant can perhaps be involved in this, too. Chair Reiter asked Commissioner Deer to see if any of his fellow commissioners would want to be engaged in that process, as well. Chair Reiter referenced consulting groups who do pro-bono work in this area, as it might be worth pursuing outside assistance. Ms. Carey asked that the Board allow the administration to first see how they can provide that information internally, before discussing bringing in outside assistance. Chair Reiter stated that he would like to start working on doing a better job of socializing the differences between CCH’s accrual-based finances and the modified cash accrual-based finances that the Commissioners are looking at. All of this Board’s documents get shared with the President’s Office, Commissioners, and their staff, but they are looking at them through a different lens; this organization needs to do a better job at providing analytics that speak to the way they are looking at CCH’s finances.


VI. Adjourn

As the agenda was exhausted, Chair Reiter declared the meeting ADJOURNED.

Respectfully submitted, Finance Committee of the Board of Directors of the Cook County Health and Hospitals System

XXXXXXXXXXXXXXXXXXXXXX Robert G. Reiter, Jr., Chair

Attest:

XXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary

Follow-up / Requests: Follow-up: The administration will follow-up on the public speaker’s questions regarding receiving

reimbursements for CountyCare claims. Page 1 Request: Regarding initial claims denials, request for information: total actual collection rate, in looking at

a 4-6 month window; monetary value of the claims that are not collected. Page 3 Request: Regarding self-pay collections, request for metrics on the contracted work done on reapplications:

understanding their success rate, their collections, and what is not collected. Page 3

Cook County Health and Hospitals System Finance Committee Meeting

February 20, 2020

ATTACHMENT #1

COOK COUNTY HEALTH AND HOSPITALS SYSTEM ITEM III(B)

FEBRUARY 20, 2020 FINANCE COMMITTEE MEETING CONTRACTS AND PROCUREMENT ITEMS

Request # Vendor/Entity Service or Product

Fiscal impact not to exceed:

Method of acquisition

Total # of bidders/ RFP responses / GPO companies

availableAffiliate / System

Begins on

Page #

1Illinois Department of Public Health

Service -comprehensive healthprotection

Grant renewal amount:

$6,457,966.00 n/a n/a CCDPH 3

2Cook County Health Foundation

Service - providingMedication-Assisted Treatment (MAT) foropioid use disorder inthe Cook County Jail

Grant renewal amount:

$94,786.00 n/a n/a System 4

3

Kore SAE, LLC (formerly STW Healthcare)

Service - temporarystaffing for Radiology,Pharmacy, Laboratory, EmployeeHealth Services andvarious departments $2,812,620.00

This request -noncompetitive

process leveraging

existing contract

Original contract -

competitive RFP process in

2017/9 responses System 5

4 Texture Health, LLC

Service - carecoordination systemfor CountyCare $1,200,000.00


process leveraging

existing contract

Original contract - Emergency Purchase in

2017Managed

Care 6

5Saldemar Solutions, LLC

Service - professionalconsulting services(SCM-AP-IT) $600,000.00


process leveraging

existing contract

Original contract -

competitive Comparable Government Procurement System 7

6 Zimmer US, Inc.Product - orthopedicsupplies and implants $2,875,000.00 RFP 6 System 8

Accept Grant Award Renewals

Execute Contracts

Amend and Increase Contract

Extend and Increase Contract

Page 1 of 18

COOK COUNTY HEALTH AND HOSPITALS SYSTEM ITEM III(B)

FEBRUARY 20, 2020 FINANCE COMMITTEE MEETING CONTRACTS AND PROCUREMENT ITEMS

Request # Vendor/Entity Service or Product

Fiscal impact not to exceed:

Method of acquisition

Total # of bidders/ RFP responses / GPO companies

availableAffiliate / System

Begins on

Page #

7

Stryker Orthopedics, a part of Howmedica Osteonics Corporation

Product - orthopedicsupplies and implants $2,562,000.00 RFP 6 System 9

8 Acumed, LLCProduct - orthopedicsupplies and implants $1,900,000.00 RFP 6 System 10

9DePuy Synthes Sales, Inc.

Product - orthopedicsupplies and implants $1,758,000.00 RFP 6 System 11

10Suburban Primary Health Care Council

Service - funding forAccess to CareProgram $1,500,000.00 Sole Source n/a System 12

11

Board of Trustees of the University of Illinois

Service - qualitativeresearch project,establish a system tomonitor real-timeopioid events

$525,513.00 (grant funded) Sub Grant n/a CCDPH 13

12Wright Medical Technology, Inc.

Product - orthopedicsupplies and implants $488,000.00 RFP 6 System 14

13

Treatment Alternatives for Safe Communities (TASC)

Service - convenethree (3) area taskforces in suburbanCook County

$450,000.00 (grant funded) Sub Grant n/a CCDPH 15

14 Arthrex Inc.Product - orthopedicsupplies and implants $378,000.00 RFP 6 System 16

15

Fresenius USA Marketing, Inc. d/b/a Fresenius Medical Care - North America

Product -hemodialysis equipment $200,242.00 Value Analysis PHCC 17

16 CDW Government

Product - informationtechnology hardwareand equipment $161,398.29 GPO 3 System 18

Execute Contracts (continued)

Page 2 of 18

AS AMENDED

----------------------------- 09/01/2020 thru 08/23/2023

-------------------------------- 09/01/2020 thru 08/23/2023

-------------------------- 8/01/2020 thru 7/31/2023

-------------------------------- 8/01/2020 thru 7/31/2023

AS AMENDED

-------------------------- 09/01/2020 thru 08/31/2023

-------------------------------- 09/01/2020 thru 08/31/2023

AS AMENDED

11/01/2020 thru 10/31/2023----------------------------

11/01/2020 thru 10/31/2023----------------------------------

-------------------------- 09/01/2020 thru 08/31/2023

--------------------------------- 09/01/2020 thru 08/31/2023

AS AMENDED

-------------------------- 09/01/2020 thru 08/31/2023

----------------------------- 09/01/2020 thru 08/31/2023

AS AMENDED


February 20, 2020

ATTACHMENT #2

MWBE METRICS - FY 2019Contracts $150,000.00 and Over for September, October, and November 2019

Month Friday, September 27, 2019 Friday, October 25, 2019 Friday, November 22, 2019 TOTAL

Number of Contracts Awarded 16 12 13 41

Total Award Value $134,929,978 $119,616,022 $25,489,304 $280,035,304Number of Contracts with

Goals 7 7 6 20Value $121,353,009 $115,396,022 $18,181,528 $254,930,559

% Total Award 90% 96% 71% 91%Number of Contracts with

MWBE as Prime 1 3 0 4Prime Award Value $150,000 $3,791,509 $0 $3,941,509% Contract w/goal 0.12% 3% 0% 2%

Number of Contracts withMWBE as Subcontractor 3 2 6 11

Sub Award Value $915,968 $38,571,032 $2,309,953 $41,796,953% Contract w/goal 1% 33% 13% 16%

Number of Contracts with Full Waivers 3 2 0 5Waiver Value $25,128,355 $1,637,500 $0 $26,765,855

% Contract w/goal 20.71% 1.42% 0% 10%

NOTE: The difference between Number of Contract Awarded and Number of Contracts with Goals = Contracts assigned a Contract specific goal of zero. This means that there were no certified MWBEs to provide the specific Good, Service or Equipment.

September reflects three full waivers that caused a downward trend in participation. The vendors did achieve some indirect participation for two of the waivers but it is only considered a good faith effort.

October reflects two full waivers; the vendor did achieve some indirect participation for one of the waivers but it is only considered a good faith effort.

See next page for MWBE Participation Bar Chart

Dollars awarded to to M/WBEs $1,065,968 $42,362,541 $2,309,953Total Dollars Awarded $121,353,009 $115,396,022 $18,181,528

Sep-19 Oct-19 Nov-191% 37% 13%

1%

37%

13%

0%

5%

10%

15%

20%

25%

30%

35%

40%

Sep-19 Oct-19 Nov-19

Percent (%) of Dollars Awarded to M/WBEs

MWBE METRICS - FY 2019Contracts $150,000.00 and Over for Fiscal Year 2019

Month Dec 2018, Jan and Feb 20191st Quarter

March, April and May 20192nd Quarter

June, July and August 20193rd Quarter

Sep, Oct, and Nov 20194th Quarter TOTAL

Number of Contracts Awarded 41 41 48 41 171

Total Award Value $1,058,339,863 $75,044,785 $89,893,879 $280,035,304 $1,503,313,831Number of Contracts with

Goals 17 23 21 20 81Value $57,759,194 $64,213,659 $74,366,745 $254,930,559 $451,270,157

% Total Award 5% 86% 83% 91% 30%Number of Contracts with

MWBE as Prime 3 2 4 4 13Prime Award Value $1,303,118 $1,704,506 $2,657,620 $3,941,509 $9,606,753% Contract w/goal 2% 3% 4% 2% 2%

Number of Contracts withMWBE as Subcontractor 12 12 14 11 49

Sub Award Value $4,148,544 $11,359,921 $9,962,335 $41,796,953 $67,267,753% Contract w/goal 7% 18% 13% 16% 15%

Number of Contracts with Full Waivers 2 9 3 5 19Waiver Value $7,227,740 $22,844,947 $1,105,027 $26,765,855 $57,943,569

% Contract w/goal 13% 36% 1% 10% 13%

NOTE: The difference between Number of Contract Awarded and Number of Contracts with Goals = Contracts assigned a Contract specific goal of zero. This means that there were no certified MWBEs to provide the specific Good, Service or Equipment.

The metrics above refelects some waivers where the vendor did achieve some indirect participation, but indirect participation is only considered a good faith effort.

See next page for MWBE Participation Bar Chart

Dollars awarded to to M/WBEs $5,451,662 $13,064,427 $12,619,955 $45,738,462 $76,874,506Total Dollars Awarded $57,759,194 $64,213,659 $74,366,745 $254,930,559 $451,270,157

1st Quarter 2019 2nd Quarter 2019 3rd Quarter 2019 4th Quarter 2019 Total FY 20199% 20% 17% 18% 17%

9%

20%

17%18%

17%

0%

5%

10%

15%

20%

25%

1st Quarter 2019 2nd Quarter 2019 3rd Quarter 2019 4th Quarter 2019 Total FY 2019

Percent (%) of Dollars Awarded to M/WBEs for Contracts $150,000.00 and Over

CCHHS MBE/WBE Commitment Report for Board Meeting on November 22, 2019

Board Items Page 1M/WBE Ethnicity Codes: 6 - African-American; 7 - Caucasian Female; 8 - Asian; 9 - Hispanic;

13 of 17 board items required Office of Contract Compliance responsive letters

Contract No.

Agenda Item No.

User Department Vendor Commodity Contract TypeContract Goal

%Fiscal Impact

MBE % Committed

WBE % Commited

Details of Participation

H15-25-011 5 System Wide Cardinal HealthProduct - Distribution of

Medical and Surgical Supplies

RFP25% MBE and

10% WBE Participation

$12,166,667.00 0.622% 0%

This is amendment no. 5. The total contract value is $139,083,334.00.

Partial MBE/WBE waiver is granted due to the specifications and necessary requirements for performing the contract make it impossible or economically infeasible to divide the contract to enable the contractor to further utilize MBEs and/or WBEs in accordance with the applicable participation.

The vendor has committed to utilizing:EKLA Corporation - MBE(8) - 0.617% Direct or $858,124.00 for distribution of medical supplies and equipment.LSL Industries, Inc. - MBE(8) - 0.004% Direct or $5,825.00 for distribution of medical supplies and equipment.Action Bag Company -WBE(7)- 0.001% Direct or $1,262.98 for plastic bags.

For a total of 0.622% direct participation

Global Capital, Ltd. - WBE(7) - 14.25% Indirect or $19,820,730.00 for assest management services.

Note indirect participation does not count towards meeting the MBE/WBE goals and is only considered a good faith effort.

H16-25-132 6 Surgery DePuy Synthes Sales, Inc.Product - Trauma Implants and Orthopedic Supplies

RFP 0% $860,000.00 0% 0%

The contract-specific goal set on this contract was zero based on information such as the scope of work, the estimated project cost, the current availability of certified M/WBEs in the marketplace to provide the goods necessary to fulfill the contract requirements and with the consultation of the User Agency.




Contract No.

Agenda Item No.


%Fiscal Impact

MBE % Committed

WBE % Commited


H17-25-019 7Health Information

SystemsTeletracking

Technologies, Inc.

Service - Software Support, Maintenance and

EnhancementsSole Source

35% MWBE Participation

$510,731.00 4.54% 0%

This is amendment no. 1 for $510,731.00. The total contract amount is $1,368,329.00.

Partial MBE/WBE waiver is granted due to other relevant factors makeing it economically infeasible to further utilize MBEs and/or WBEs in accordance with the applicable participation.

The vendor has committed to utilizing:

System Solutions, Inc., MBE(8) for $62,117.00 or 4.54% direct participation for computer hardware.

H15-25-025 8Supply Chain Management

Guy Brown Management, LLC

Product and Service - Office Supplies

RFP25% MBE and


$426,000.00 19.65% 0%

This is amendment no. 5 for $426,000.00. The total contract amount is $2,712,580.47.



Delivery & Distribution Solutions, LLC, MBE(6) for $533,143.92 or 19.65% direct participation for delivery of office supplies.

H12-25-070 9Finance and

Revenue CycleAjilon Professional

StaffingService - Temporary

StaffingRFP

35% MWBE Participation

$210,000.00 23.48% 0%




Professional Dynamic Network, Inc., MWBE(6) for $1,325,577.73 or 22.00% direct participation for temporary staffing.

Professional Systems, Inc. MBE(6) for $89,446.15 or 1.48% direct participation for temporary staffing.

For a total of 23.48% direct participation




Contract No.

Agenda Item No.


%Fiscal Impact

MBE % Committed

WBE % Commited


H16-25-007 10 Laboratory Beckman Coulter, Inc.

Product and Service - Lab Automation Equipment, Reagents, Services and

Software

RFP25% MBE and


$4,148,130.00 6% 0%



The vendor has committed to: International Quality Contracting, Inc., MWBE(6) for $999,607.00 or 6% direct participation to provide construction installation of equipment.

H20-25-010 11 Medical ImagingGE Healthcare IITTS USA

Corporation

Service - Maintenance and Repair for the Picture

Archiving and Communication System (PACS), including System

Upgrades

GPO 0% $4,802,292.00 0% 0%


H20-25-013 12 - 1 Provident Hospital McDonagh ConstructionService -Demolition of

Sengstacke Health CenterRFP

24% MBE and 10% WBE

Participation$720,000.00 24.30% 10.42%

The vendor committed to utilizing:

Martinez Frogs, Inc., MBE (9) for $140,000.00 or 19.44% direct participation to provide trucking services.

Nes, Inc., MBE (9) for $35,000.00 or 4.86% direct participation to provide environmental remediation services.

AMS Elite Solutions, Inc., WBE (7) for $35,000.00 4.86% direct participation to provide trucking services.

Comprehensive Construction Solutions, LLC., WBE (7) for $40,000.00 or 5.56% direct participation to provide HVAC services.

For a total of 34.72% direct participation.




Contract No.

Agenda Item No.


%Fiscal Impact

MBE % Committed

WBE % Commited


H20-25-012 13Anesthesiology

and Pain Management

Medtronic USA, Inc.

Product - Spinal Cord Stimulation Products and

Spinal Column Stimulators, Intrathecal

Pumps

Sole Source 0% $565,000.00 0% 0%

On this Sole Source contract, the contract-specific goal set on this contract was zero based on information such as the scope of work, the estimated project cost, the current availability of certified M/WBEs in the marketplace to provide the goods necessary to fulfill the contract requirements and with the consultation of the User Agency.

H20-25-014 14 Integrated Care Management

Medical Resource Analytics and Informatics

Alliance (MRAIA)

Service - Central Data Repository Administrator

for Chicago HIV Interactive Linkage Network

RFP 0% $406,000.00 0% 0%


H20-25-011 15 Medical Imaging Vision RT, Inc.

Service - Comprehensive Service and Support

Contract for the Vision RT System, including Service

Upgrades

Sole Source 0% $209,319.00 0% 0%


H20-25-016 16Health Information

SystemsAmerican Messaging

SystemsService - Pager Services Sole Source 0% $182,400.00 0% 0%


H20-25-009 17 PathologyBoard of Trustees of the

University of Illinois

Service - Neuropathologist and Derma Pathology

Consulting Services with UIC Department of

Pathology

Sole Source 0% $282,765.00 0% 0%



February 20, 2020

ATTACHMENT #3

CCH Finance Committee Meeting February 2020

Ekerete Akpan, Chief Financial OfficerFebruary 20, 2020

Agenda1. Jan-2020 Leading indicators

a. Revenue Cycle metrics and observations as of Jan-2020

b. FY 2020 Gross Charges as of Jan-2020

c. Charity care and Self pay costs vs. DSH/BIPA as of Jan-2020

d. Preliminary Cash Flow projections as of January 2020

2. System wide Dec-2019 Accrual Basis Income Statement and Observations

a. CCH Provider Service Financials , Operational Statistics and Observations

b. County Care Financials & Stats

c. Correctional Health services Financials & Stats

d. Cook County Department of Public Health Financials & Stats

e. Administration Financials

3. Appendix - FY 2020 System-wide volumes/stats

2

January 2020 Leading IndicatorsRevenue Cycle Metrics, Gross Charges and Uncompensated Care vs. DSH/BIPAPreliminary Cash Flow Projections

FYTD 2020 - Revenue Cycle Metrics as of end Jan-2020

4

: Total accounts receivable over average daily revenue: Total charges of discharge not finally billed over average daily revenue

: Percentage of claims denied initially compared to total claims submitted.*Source HFMA Key Hospital Statistics and Ratio Margins from Cerner

Metric Average FYTD2019

Average FYTD2020

Dec-19 Jan-20

CCH

Benchmark

/Targets

Some

Industry

Targets

Average Days in Accounts Receivable (lower is better)

97 88 88 88 60-65 40*

Discharged Not Finally Billed Days (lower is better)

11 8 8.3 8 5 7*

Claims Initial Denials Percentage (lower is better)

20% 20% 20% 19% 10% 3%*

Observations on Revenue Cycle Metrics

Sustained year over year improvements

Cash collections for FYTD 2020 up 23% to $72.8M from $59.4M for same period in FY2019

Case mix index continues to improve by 6% year over year, indicating greater focus on clinical documentation

and coding

Average days in Accounts Receivables at 88 days, improving with focus on getting to target days in AR

Discharged Not Finally Billed (DNFB) at 8 days improving with focus on “coding-ready” encounters especially

for high dollar inpatient discharges and concurrent coding for long stay patients prior to discharges

Initial Claims Denials – improving to 19% with focus on upstream processes and activities including pre-

authorization, pre-certification and accurate registration. Specific activities aligned with patient accounting

implementation there is room for continued improvement.

5Source: Finance Department, Business Intelligence & CountyCare

FYTD 2020 – Gross Charges as of end Jan-2020 (in $ millions)

6Source: Unaudited Financials Charge Reports , FY2020 Cook County /CCH Budget Book

2019 2020 2019 vs.2020

2019 vs.2020

%tage

2020 BudgetTarget

Charges with Reimbursement Potential 160.11 164.96 4.84 3.0%

Charges with NO Reimbursement Potential 106.06 131.06 25.00 23.6% 8.5%

Total 266.17 296.01 29.84 11.2%

2019v2020

%tage2019 2020 2019vs. 2020

COMMERCIAL $ 16.46 $ 15.00 $ (1.46) -8.9%

COUNTYCARE $ 38.82 $ 42.42 $ 3.60 9.3%

MEDICAID $ 31.89 $ 23.07 $ (8.82) -27.7%

MEDICAID MGD CARE $ 30.72 $ 38.29 $ 7.57 24.7%

MEDICARE $ 30.63 $ 31.53 $ 0.90 2.9%

MEDICARE MGD CARE $ 11.59 $ 14.65 $ 3.06 26.4%

CHARITY CARE $ 64.52 $ 68.82 $ 4.29 6.7%

SELF PAY $ 37.41 $ 58.69 $ 21.28 56.9%

Others $ 4.12 $ 3.54 $ (0.58) -14.0%

Grand Total $266.17 $296.01 $ 29.84 11.2%

$40M$43M

$23M

$37M

FY2019 FY2020

Charity Care Cost Self Pay

FYTD 2020 - Charity Care & Self Pay Cost vs. DSH/BIPA funding as of end Jan-2020

7

Source: Unaudited Financials Charge Reports , FY2020 Cook County /CCH Budget BookDSH: Disproportionate Share Hospital Payments-$156.7M/YearBIPA: Benefits Improvement and Protection Act Payments-$132.3M/Year

Gap $15M

Gap – $32M

DSH/BIPA $48M

FY2020 – CCH Hospitals & Clinics - Preliminary Cash Flow Projections as of end Jan-2020 (in millions)

8Source: Finance Department

MonthProjected Cash

ReceiptsProjected Expenses

Projected Earnings from Health Plans

Net Cash Flow

Dec-19 $ 57.10 $ (124.46) $ - $ (67.36)Jan-20 57.10 (124.46) - (67.36)Feb-20 57.10 (94.46) 38.00 0.64 Mar-20 54.25 (84.46) 15.00 (15.21)Apr-20 54.25 (84.46) 15.00 (15.21)May-20 54.25 (84.46) 15.00 (15.21)Jun-20 54.25 (84.46) 15.00 (15.21)Jul-20 54.25 (84.46) 15.00 (15.21)

Aug-20 150.80 (84.46) 15.00 81.34 Sep-20 54.25 (84.46) 15.00 (15.21)Oct-20 54.25 (84.46) 15.00 (15.21)Nov-20 90.92 (84.46) 15.00 21.46

Total $ 792.73 $ (1,103.50) $ 173.00 $(137.77)

CCH Hospitals & Clinics as a

provider of care, cash flows are

positive in August and November

due to payments of BIPA.

Due to increasing and

unsustainable growth in charity

care, and predominantly

government payors, CCH

projected expenses exceed its

cash flows and will impact CCH

ability to meet budget.

CCH must earn Health plan

business of $173M for FY2020

by serving Countycare/MoreCare

members

FY2020 – Correctional Health / CCDPH Preliminary Cash Flow projections as of end Jan-2020 (in millions)

9

Source: Finance Department

Correctional Health /CCDPH

cashflow dependent on property

tax receipts, cashflow based on

FY2019 experience .

Correctional Health/CCDPH

projected expenses exceed its cash

flows for Cook County mandated

services

Month

Projected Property Tax

ReceiptsProjected Expenses Net Cash Flow

Dec-19 $ 0.17 $ (8.46) $ (8.29)Jan-20 4.83 (8.46) (3.63)Feb-20 7.19 (8.46) (1.27)Mar-20 36.22 (8.46) 27.77 Apr-20 1.29 (8.46) (7.17)

May-20 0.59 (8.46) (7.87)Jun-20 4.45 (8.46) (4.00)Jul-20 4.34 (8.46) (4.12)

Aug-20 22.04 (8.46) 13.58 Sep-20 0.70 (8.46) (7.75)Oct-20 0.82 (8.46) (7.64)Nov-20 0.35 (8.46) (8.11)

Total $ 83.00 $ (101.50) $ (18.50)

FY2020 – Health Plans Preliminary Cash Flow projections as of end Jan-2020 (in millions)

10

Source: Finance Department

Health plans cashflows particularly

exposed to State payments cycles

HealthPlan does not make direct to

CCH, however, residual PMPM not

paid to external providers is

retained by CCH hospitals & Clinics.

CCH Hospitals and Clinics must earn

Health plan business by serving

Countycare/MoreCare members

MonthProjected PMPM

ReceiptsProjected Claims

Expenses

Net Cash Flow to CCH Hospital &

Clinics

Dec-19 $ 48.00 $ (48.00) $ -

Jan-20 66.00 (66.00) -

Feb-20 450.00 (412.00) 38.00

Mar-20 150.00 (135.00) 15.00

Apr-20 150.00 (135.00) 15.00

May-20 150.00 (135.00) 15.00

Jun-20 150.00 (135.00) 15.00

Jul-20 150.00 (135.00) 15.00

Aug-20 150.00 (135.00) 15.00

Sep-20 150.00 (135.00) 15.00

Oct-20 150.00 (135.00) 15.00

Nov-20 150.00 (135.00) 15.00

Total $ 1,914.00 $ (1,741.00) $ 173.00

FY2020 - Systems-wide Accrual Basis Financials, Observationsas of end December 2019

Accrual Basis Income Statement for the One Month ending December 2019 (in thousands)

12

*Year to Date (1 month) Pension Liability per GASB Pension includes Other Post Employment Benefits (OPEB) Expense

Internal Claims based on paid claims and estimated IBNR provided by third-party actuaries priced at 100% of Medicaid rates Unaudited Financial Statement

Observations on Accrual Basis Financials

CCH Hospitals & Clinics as a provider of care, Net Patient Service Revenues - $63M, 11% unfavorable to target due to

increasing and unsustainable growth in charity care, this is above the 8.5% budgeted and will impact CCH ability to

meet budget.

• System-wide uninsured numbers

• Captured by Visits, increased to 46%

• Captured by Charges, increases to 45%

CountyCare Capitation Revenues - $146.8M, 1% unfavorable to target due to lower than budgeted enrollment

(currently approximately 319,000 members vs. 326,000) as a result of lower State/County MCO enrollment.

CountyCare retains market share of approximately 31.5%.

State owed CountyCare $170M of past due capitation payments as of end December -2019 with $246M in

adjudicated but not paid claims pending action.

13Source: Finance Department, Business Intelligence & CountyCare

Observations on Accrual Basis Financials

Personnel Costs - Salary & Benefits expenses - exceeding budget by $3.2M or 6% and Overtime expenses -

exceeding budget by $1.5M of 58%

CCH is embarking on an immediate review of vacancies and programs with operational and clinical leaders to

prioritize hiring, ensure we come within budgeted vacancy factor of 900 FTEs vs current vacancies of

approximately 600 FTEs including as significant number of clinical positions needed to continue services at

current levels.

Other than Personnel Costs - Supplies & Materials and Pharmaceutical Supplies exceeding budget, Purchase

Services Rental others including Agency Expenses exceeding budget

CCH is embarking on an immediate review of all other than personnel costs with operational and clinical

leaders to ensure we come within budget, including a review of programs with contracted agency costs


Provider of Care ServicesFinancial and Operational Statistics

CCH Provider - Accrual Basis Income Statement for one month ending December 2019 (in thousands)

16Unaudited Financial Statement


Internal Claims based on paid claims and estimated IBNR provided by third-party actuaries priced at 100% of Medicaid rates

Clinical Activity Observations

Primary Care visits are up by 10% versus FY18, and up 6% versus FY19 target

Specialty Care visits are up by 15% versus FY18 up 11% versus FY19 target

Surgical Cases are up by 7% versus FY19, and down 2% versus FY20 target

Inpatient Discharges are up by 10% versus FY19

Length of Stay is down by 2% versus FY19, and down 2% versus FY20target

Emergency Department visits are up by 3% versus FY19

Deliveries are up by 1% versus FY19 and up by 7% versus FY20 target

17Source: CCH Tableau Dashboards

Stroger Operations Overview for one month ending December 2019

Comments:

• Growth primary and specialty care provider visits continue in FY2020

targets

• Payor mix challenges continue vs FY 2020 budget assumptions

18

CHARITY CARE$30M

COMMERCIAL$6M

MEDICAID$10M

MEDICAID MANAGED CARE $17M

COUNTYCARE$18M

MEDICARE$15M

MEDICARE MANAGED CARE

$6M

SELF PAY$28M

GROSS CHARGES

Source: Charge Report & Business Intelligence

Provident Operations Overview for one month ending December 2019

Comments:

• Growth in primary care and specialty care provider visits continues in FY2020

Leadership reviewing left without being seen in Emergency Dept.

• Challenging payor mix though better than rest of system on average

19

CHARITY CARE$1M

COMMERCIAL413K

MEDICAID$456K

MEDICAID MANAGED CARE

$1M

COUNTYCARE $2M

MEDICARE$852K


$380K

SELF PAY $2M

GROSS CHARGES


ACHN Operations Overview for one month ending December 2019

Comments :

• Growth trends in Primary care and Specialty care provider visits

continues in FY2020

• Challenging payor mix trends with non-reimbursable payors generally

higher than rest of system

20

*includes All OBGYN clinics , Ped Primary on Stroger campus *excludes Stroger Specialty Care, CORE, Stroger-Hospital Based Clinics, Sengstacke GMC & Psych, Austin Behavioral Health, and assuming all registrations are provider visits

CHARITY CARE$3M

COMMERCIAL$504K

MEDICAID$415K

MEDICAID MANAGED CARE $1M

COUNTYCARE $2M

MEDICARE$728K


$307K

SELF PAY$2M

GROSS CHARGES


CountyCare Health PlanFinancial and Operational Statistics

Health Plans – Accrual Basis Income Statement for one month ending December 2019 (in thousands)


*Internal Claims based on paid claims and estimated IBNR provided by third-party actuaries priced at 100% of Medicaid rates**Cook County Health reflects a refundable deposit asset of $50 million. The actual balance of this deposit may vary due to claims payment timing, however, replenishment of the deposit is reflected in Claims Payable on the balance sheet.

Correctional Health ServicesFinancial & Operational Statistics

Accrual Basis Income Statement for one month ending December 2019 (in thousands)


*Year to Date (1 months) Pension Liability per GASB Pension includes Other Post Employment Benefits (OPEB) Expense

0

500

1000

1500

2000

2500

3000

3500

4000

Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov

Total Intakes

2019 Actual 2020 Actual

for one month ending

Comments:• 91% of intakes are screened by financial counselling to ensure continuity of coverage

25Source: Cermak Health Services – Financial Counseling

Cook County Dept. of Public HealthFinancial & Operational Statistics

Accrual Basis Income Statement for one month ending December 2019 (in thousands)


*Year to Date (1 months) Pension Liability per GASB Pension includes Other Post Employment Benefits (OPEB) Expense

28Source: Department of Public Health

CCH AdministrationFinancial Statements

29

Accrual Basis Income Statement for one month ending December 2019(in thousands)

30

Unaudited Financial Statement


AppendixFY 2020 - System-wide Volumes / Stats

0%

25%

21%

5%4%

12%

16%

15%

1%

County Care

UncompensatedCare= 46%

Self PayAll Medicaid = 32%

All Medicare

System Payor Mix By Visit as of December 2019

32Source: Tableau Dashboards & Business Intelligence

23%32M

22%31M

5%7M

7%10M

13%19M

14%21M

16%23M

Charity Care

Other (SelfPay)

CommerciallyInsured

Medicaid

MedicaidManaged Care

County Care

Medicare

Charity CareCounty Care

Self Pay

UncompensatedCare = 45% 63M

All Medicaid = 34%50M

All Medicare

System Payor Mix By Charges as of December 2019


10000

30000

Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov2020 Target 2019 Actual 2020 Actual

Primary Care Provider Visits


10000

40000


2020 Target 2019 Actual 2020 Actual

Specialty Care Provider Visits


1,000

2,000



Total Inpatient Discharges


0.00

10.00



Average Length of Stay

37Source: Business Intelligence

10,000

15,000


2020Target 2019 Actual 2020 Actual

Total Emergency Room Visits

38Source: Tableau Dashboard

50

150



Total Deliveries


1,000

1,500



Total Surgical Cases


1.66

1.55

1.49

1.611.60

1.59

1.73

1.62

1.59

1.64

1.62

1.60


FY19 FY20

Case Mix Index

41Source: Tableau Dashboard

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